Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

A century ago, “diet was commonly used as [part of the] treatment for acne. During the 1960s, however, the diet-acne connection fell out of favor.” Why? Because of a study purported to “prove…that chocolate had no influence on acne, by comparing a chocolate bar to a pseudochocolate bar composed of 28% [pure trans-fat laden, partially] hydrogenated vegetable oil, a [substance] known to increase [signs of inflammation].” Compared to that, no wonder the chocolate didn’t come out looking so bad.

And then, there was this other study, where small groups of medical students ate a variety of purported culprits, and only about a third broke out. But, there was no control group to compare to. Yet, these two studies, despite their “major design flaws, were sufficient to dissociate diet from acne in the minds of most dermatologists. Textbooks were revised to reflect this new academic consensus, and dermatologists took the stance that any mumblings about the association between diet and acne were unscientific and one of the many myths surrounding this ubiquitous disease.”

Comments such as “The association of diet with acne has…been relegated to the category of myth” “are commonplace in both the past and current [medical] literature.” Yet, the major dermatology textbooks “promulgat[ing this] notion that diet and acne are unrelated…rely only on” those two flawed studies. So, this current thought “within the dermatology community that diet and acne are unrelated has little or no factual support.”

And, there’s reason to suspect chocolate consumption may be an issue. If you take blood from people before and after eating a couple bars of milk chocolate, the milk chocolate appears to prime some of their pus cells to release extra inflammatory chemicals when you expose them to acne-causing bacteria in a petri dish. So, maybe this is “one of the mechanisms that could explain the effects of chocolate on acne.” But, how do we know it’s the chocolate, and not the added sugar or milk?

Yes, if you survey teens on their acne severity and eating habits, there appears to be a link to chocolate consumption. But, is that people sprinkling cocoa powder in their smoothie, or eating dark chocolate? Or, is it because of the added sugar and milk?

Just cutting down on sugary foods and refined grains can cut pimple counts in half in a few months—significantly better than the control group, complete with compelling before-and-after pictures.

To tease out if it was the sugar, researchers gave people milk chocolate versus jelly beans. If it was just the sugar, then acne would presumably get equally worse in both groups. But, instead, the chocolate group got worse—a doubling of acne lesions, whereas no change in the jelly-bean group. So, it’s apparently not just the sugar; maybe there is something in chocolate. Or is it only in milk chocolate?

“So far, there [had] been no studies assessing the effects of pure [100%] chocolate…on acne”—that is, until there were! “57 volunteers with mild-to-moderate acne…were randomized in[to] three groups, receiving…” white chocolate bars, dark chocolate bars, or no chocolate bars every day for a month. And, this wasn’t just dark chocolate, but 100% chocolate, meaning like baker’s chocolate. Unlike pure dark chocolate, white chocolate is packed with sugar and milk. And, indeed, acne lesions worsened in the white-chocolate group, but not in the dark-chocolate or control groups. So, in “this study, white but not dark chocolate consumption [was] associated with [an] exacerbation of acne lesions.

But, other studies did show acne worsening on dark chocolate. Give research subjects a single big load of Ghirardelli baking chocolate, and they break out within days. A “[s]ignificant increase…in the total average number of acne…lesions” within four days. And, same thing with more chronic dark chocolate consumption: a half a small chocolate bar a day for a month, and increased acne severity was reported within two weeks, with before-and-after pictures looking like this.

Okay, but what was lacking in these two studies? Give people chocolate every day, and their acne gets worse, or one big load of chocolate and their acne gets worse. What didn’t these studies include? Long-time NutritionFacts followers should know this by now. Right, they’re missing a control group.

If you look at surveys, most people believe chocolate causes acne. So, if you give people a big load of chocolate, maybe just the stress and expectation that they’re going to have an outbreak contributes to the actual outbreak. To really get to the bottom of this, you’d have to design a study where you give people disguised chocolate. You expose people to chocolate without them knowing it, and see if they still break out. Like, you could put cocoa powder into opaque capsules, so they don’t know if they’re getting cocoa or placebo. And, that would have the additional benefit of eliminating the cocoa-butter fat factor. No milk, no sugar, no fat—just pure cocoa powder in capsules, versus placebo. But, there had never been such a study… until now.

“A double-blind, placebo-controlled study assessing the effect of chocolate consumption,” actually cocoa powder consumption, “in subjects with a history of acne…” They were “assigned to swallow capsules filled with either unsweetened 100-percent cocoa,” or a placebo of like an unflavored, unsweetened jello powder. Just a “one-time binge,” requiring the swallowing of up to “240 capsules” to try to secretly expose people to a few ounces of cocoa powder. And, the same significant increase, the same doubling of acne lesions within four days, like in that Ghirardelli study. So, sadly, it really does appear that in acne-prone individuals, the consumption of cocoa may cause an increase in acne.

Now, the study did just include men. So, they didn’t have to deal with cyclical hormonal changes. And, it’s hard to imagine that the real cocoa group, after swallowing hundreds of capsules, didn’t burp up some cocoa taste, and know they were not just in the placebo group. But, the best available balance of evidence does suggest that if you’re bothered by acne, you may want to try backing off on chocolate to see if your symptoms improve.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

A century ago, “diet was commonly used as [part of the] treatment for acne. During the 1960s, however, the diet-acne connection fell out of favor.” Why? Because of a study purported to “prove…that chocolate had no influence on acne, by comparing a chocolate bar to a pseudochocolate bar composed of 28% [pure trans-fat laden, partially] hydrogenated vegetable oil, a [substance] known to increase [signs of inflammation].” Compared to that, no wonder the chocolate didn’t come out looking so bad.

And then, there was this other study, where small groups of medical students ate a variety of purported culprits, and only about a third broke out. But, there was no control group to compare to. Yet, these two studies, despite their “major design flaws, were sufficient to dissociate diet from acne in the minds of most dermatologists. Textbooks were revised to reflect this new academic consensus, and dermatologists took the stance that any mumblings about the association between diet and acne were unscientific and one of the many myths surrounding this ubiquitous disease.”

Comments such as “The association of diet with acne has…been relegated to the category of myth” “are commonplace in both the past and current [medical] literature.” Yet, the major dermatology textbooks “promulgat[ing this] notion that diet and acne are unrelated…rely only on” those two flawed studies. So, this current thought “within the dermatology community that diet and acne are unrelated has little or no factual support.”

And, there’s reason to suspect chocolate consumption may be an issue. If you take blood from people before and after eating a couple bars of milk chocolate, the milk chocolate appears to prime some of their pus cells to release extra inflammatory chemicals when you expose them to acne-causing bacteria in a petri dish. So, maybe this is “one of the mechanisms that could explain the effects of chocolate on acne.” But, how do we know it’s the chocolate, and not the added sugar or milk?

Yes, if you survey teens on their acne severity and eating habits, there appears to be a link to chocolate consumption. But, is that people sprinkling cocoa powder in their smoothie, or eating dark chocolate? Or, is it because of the added sugar and milk?

Just cutting down on sugary foods and refined grains can cut pimple counts in half in a few months—significantly better than the control group, complete with compelling before-and-after pictures.

To tease out if it was the sugar, researchers gave people milk chocolate versus jelly beans. If it was just the sugar, then acne would presumably get equally worse in both groups. But, instead, the chocolate group got worse—a doubling of acne lesions, whereas no change in the jelly-bean group. So, it’s apparently not just the sugar; maybe there is something in chocolate. Or is it only in milk chocolate?

“So far, there [had] been no studies assessing the effects of pure [100%] chocolate…on acne”—that is, until there were! “57 volunteers with mild-to-moderate acne…were randomized in[to] three groups, receiving…” white chocolate bars, dark chocolate bars, or no chocolate bars every day for a month. And, this wasn’t just dark chocolate, but 100% chocolate, meaning like baker’s chocolate. Unlike pure dark chocolate, white chocolate is packed with sugar and milk. And, indeed, acne lesions worsened in the white-chocolate group, but not in the dark-chocolate or control groups. So, in “this study, white but not dark chocolate consumption [was] associated with [an] exacerbation of acne lesions.

But, other studies did show acne worsening on dark chocolate. Give research subjects a single big load of Ghirardelli baking chocolate, and they break out within days. A “[s]ignificant increase…in the total average number of acne…lesions” within four days. And, same thing with more chronic dark chocolate consumption: a half a small chocolate bar a day for a month, and increased acne severity was reported within two weeks, with before-and-after pictures looking like this.

Okay, but what was lacking in these two studies? Give people chocolate every day, and their acne gets worse, or one big load of chocolate and their acne gets worse. What didn’t these studies include? Long-time NutritionFacts followers should know this by now. Right, they’re missing a control group.

If you look at surveys, most people believe chocolate causes acne. So, if you give people a big load of chocolate, maybe just the stress and expectation that they’re going to have an outbreak contributes to the actual outbreak. To really get to the bottom of this, you’d have to design a study where you give people disguised chocolate. You expose people to chocolate without them knowing it, and see if they still break out. Like, you could put cocoa powder into opaque capsules, so they don’t know if they’re getting cocoa or placebo. And, that would have the additional benefit of eliminating the cocoa-butter fat factor. No milk, no sugar, no fat—just pure cocoa powder in capsules, versus placebo. But, there had never been such a study… until now.

“A double-blind, placebo-controlled study assessing the effect of chocolate consumption,” actually cocoa powder consumption, “in subjects with a history of acne…” They were “assigned to swallow capsules filled with either unsweetened 100-percent cocoa,” or a placebo of like an unflavored, unsweetened jello powder. Just a “one-time binge,” requiring the swallowing of up to “240 capsules” to try to secretly expose people to a few ounces of cocoa powder. And, the same significant increase, the same doubling of acne lesions within four days, like in that Ghirardelli study. So, sadly, it really does appear that in acne-prone individuals, the consumption of cocoa may cause an increase in acne.

Now, the study did just include men. So, they didn’t have to deal with cyclical hormonal changes. And, it’s hard to imagine that the real cocoa group, after swallowing hundreds of capsules, didn’t burp up some cocoa taste, and know they were not just in the placebo group. But, the best available balance of evidence does suggest that if you’re bothered by acne, you may want to try backing off on chocolate to see if your symptoms improve.

110 responses to “Does Cocoa Powder Cause Acne?”

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170 grams of 100% cocoa in one sitting seems like a lot to me. People don’t normally eat so much chocolate, let alone pure cocoa, at one time. It would have been interesting to see normal chocolate intake levels.

OK, how does this conclusion reconcile with the previous information presented on the Kuna Indians, who eat loads of cocoa every day and are very healthy without any prevalence of the major western diseases? The theory is that the flavanols in the cocoa has a good effect on the production of nitric oxide, which provides the health benefits. Has anyone checked to see if this group has a lot of acne, but are otherwise very healthy? How can a food that is otherwise very healthy cause such detrimental skin effects? Just wondering out loud :-)

Hal, I was thinking the same thing about the Kuna Indians. If you google photos of the Kuna Indians, they actually appear to have beautiful skin. Not saying google images is the greatest science lol, but nonetheless.

Good stuff. I personally found that by avoiding wheat and other flour products that likely have vegetable oils added to them, I stopped getting breakouts. A teenager once solicited my advice on how to get of her acne. Let’s just say she was not happy about giving up the pastry she was eating for lunch.

Hi, Matt K. In my experience, people are never happy to hear that foods they like may be harming their health in some way. It makes sense that foods that contribute to inflammation could exacerbate acne.

Not specifically related to this video, but at the end it’s mentioned the last study was only conducted on men due to men not having hormonal cycles and I’m wondering if that’s really true. A quick google search brings up a number of articles stating men do have hormonal cycles but they don’t seem to be well cited and I haven’t had time to dig deeper. Does anyone know of any studies conducted on this?

Would this be the same for cacao powder? I don’t consume cocoa powder due to sensitivity but I still have small amounts of cacao because it doesn’t seem to upset my stomach in the same way. I am very acne prone though so I’m wondering if there’s any studies that focus on cacao powder?

Cacao powder and cocoa powder are not the same. Cacao powder is processed at low heat to remove some of the cacao butter.
Cocoa powder is basically cacao powder that is then processed at high heat, which makes it less bitter, and removes more of the fat.
I haven’t seen any actual studies, but many sites state that cacao powder has higher nutritional value due to it being less processed.

They’re from the same bean but cacao is less processed than cocoa, often referred to as being raw. If it doesn’t upset you and your skin doesn’t react negatively to it then it’s probably fine. But if you’re breaking out and are trying to find the culprit, you could take some time off of it and see if you notice a difference. I think it depends on the person, some have suggested it’s a histamine issue which some people are intolerant to.

veggi n, as far as naturally occurring from the soil, most plants contain heavy metals, luckily our bodies don’t seem to hold onto heavy metals from plants like they do when we ingest them from animal “foods,” as Dr. Greger points out in one of his videos. I personally eat cacao daily, I’ve gotten my blood tested for heavy metals (lead, cadmium, etc.) and my results came back great despite heavy cacao consumption. I would be more worried about adulteration of powders, but II make it a point to buy from reputable companies.
Also, as talked about in another video of Dr. Greger’s, the Kuna Indians drink cup after cup of cacao daily and they’re known for their low disease rates which scientists believe is due to their cacao consumption.

It’s not a scientific experiment, only a set of twins who totally cleared their acne in five weeks, but the change is so profound, and the diet they adopted so healthy, it would certainly be harmless to try, and should net many health benefits during a few weeks’ trial. No more constipation, better fingernails, less chance of catching colds, more energy, faster athletic recovery times, and on and on…

Rebecca, The story of the twins and acne brings up a question regarding the usual diets of the 14 men tested in this cocoa study: What was their usual diet? It could have been a mixture of anything from WFPB to SAD. Could a such a small sample size really eliminate the effects of these other confounding variables? It would be interesting to see this same cocoa study done with all WFPB eaters.

Further, the study apparently involved feeding solely monounsaturated fat. Nobody actually eats only monounsaturated fat. Even olive oil (not a whole food in any case) also contains polyunsaturated fat and saturated fat in addition to monounsaturated fat. The ratio of different fats to each other may also be a factor as well as the fat to carbohydrate ratio, the fat to protein ratio etc.

My take is that this study confirms the WHO view that high fat diets promote weight gain and poor health, irrespective of the type of fat. However, extrapolating from this to assume that monounsaturated fat is especially unhealthy would be a stretch. Using that logic, because people die from drinking too much water, we would have to argue that drinking water is unhealthy.

Did the double-blind placebo controlled study use Dutch Processed cocoa or raw cacao powder. Have there been any double-blind placebo controlled studies that evaluate if the additional heat and alkali exposure of Dutch Cocoa makes any difference regarding increased acne or improved artery function?

I searched through the research design for the study Dr. Greger cited, but alas, there was no mention if cocoa powder was processed with heat and alkali (in other words, Dutch Cocoa or natural) so can make no conclusions about which might be better for acne. As to which might be better for artery function-
Check out this NF blog https://nutritionfacts.org/2015/11/05/how-dark-chocolate-affects-our-arteries/ which indicates that natural cocoa powder seems to be better for opening arteries. Only a teaspoon of natural cocoa powder did the same amount of artery dilation as “a tablespoon of more” of Dutched cocoa.

I did review the original study to determine if research design clarified what type of capsule, but it was not defined, and I’m thinking if the researchers went to the trouble of arranging for vegan capsules, they probably would’ve mentioned it. Still earlier studies that were cited mentioned chocolate seemed to cause the same effect through the ingestion of chocolate bars. and the study design made clear that all participants were eating ingesting the capsules, which wouldn’t explain the significant difference between those with more lesions and would give more credance to chocolate being the culprit. Still you brought up a good point and it’s clear you’re thinking like a careful researcher. Good for you!

1 Does cocoa powder, a finished processed product, cause acne? yes, but only in some people.

2 Was the acne caused by the beans or the other combined products like the milk: the beans

3 If the ‘problem’ is isolated to the beans themselves, assuming is not a leaky gut, what could theoretically cause it? Lets see:

3a bean fungal micotoxins and their products from processing (fermentation, storage, transportation across Atlantic, etc)
3b bean contamination with heavy metals from soil or machinery
3c bean storage mites and their products maybe from transportation in burlap bags (not air tight)
3d an intrinsic organic molecule of the cacao beans which is unique
3e bean varietal and different composition (less likely)
3f bean new products developed during roasting (over a thousand) , less likely)

I stopped ingest a bit of cocoa every day as part of my WFPB lifestyle because it seemed to be causing gout attacks. Indeed, if you look for the highest purine content food on the planet, it’s theobromine, which is found primarily in cocoa. Gout…and acne, for that matter, are both ailments I’m wanting to avoid.

It is my understanding that gelatin supplementation can have a positive effect on the skin health. So I wouldn’t say that was a good choice for placebo. If it is true that gelatin has a positive effect on the skin then you are basically comparing cocoa to a skin treatment. There was the other study quoted that stated the consumption of baking chocolate didn’t increase acne. If we are to believe cocoa causes acne what then is in cocoa that causes acne? I am not yet convinced.

While I can’t give you a definitive answer (since it wasn’t “put to the test,” it would seem that cocoa being a concentrated source of pure chocolate, would have a similar affect to the cocoa powder that was tested. If nibs are your thing, perhaps a judicial experiment using yourself as subject could be tried…until a more official study is done?

I didn’t look it up on PubMed, but I Googled it and saw this sentence: “Learn how coffee can disrupt your hormones, elevate stress levels, damage your gut flora, and impair digestion – all of which can trigger acne”

Was my coffee damaging my gut flora?!?!?!

I had to give it up anyway, because I didn’t like it with any of the faux milks.

Thank you, Dr. Greger, for your thoughtful research on the possible connection between cocoa consumption and its effect on acne. I’m also curious about the possible link between zinc deficiency as an underlying cause for the tendency toward acne. Here is an article that examines zinc in acne-prone individuals:

We may also want to examine the quality of sleep, stress levels, anxiety, dehydration, and fiber intake in these individuals, especially since you have noted the connection between acne and breast cancer in a previous video.

I was pondering the acne and breast cancer thing and started Googling things like Chocolate and IGF, etc.

“The low glycemic-load theory postulates that a state of elevated insulin is prevented, which is also noted to inhibit the initiation of a cascade that increases androgens. More specifically, foods with high glycemic loads are known to give rise to hyperinsulinemia, which can then lead to an increase in plasma concentrations of insulin-like growth factor (IGF)-1.[18] Free IGF-1 may promote acne by inducing hyperkeratosis and epidermal hyperplasia,[19,20] which is an initial step in the formation of a follicular obstruction. IGF-1, in addition to insulin, can also stimulate androgens, which are known to cause an increase in sebum production.[21] Clinically, there is evidence that patients with acne have higher serum levels of IGF-1, as seen in the Cappel et al. study evaluating postadolescent women aged 20-25 years.[18]”

So many topics have opposing theories that it genuinely is hard for a newbie to understand any of it properly.

When I was researching frequency healing of Cancer, what I remember is that one group was trying to use authentic Rife frequencies and the other group was saying, “No, we have moved past that understanding, we know that some of those frequencies kill.” and some of us, are genuinely not science people and didn’t buy anything and moved to useless supplements and useless pasteurized carrot juice, which probably had a few toxic things in it, on top of not helping at all.

The good news is that I followed a whole train of disinformation and misinformation and misunderstood communication and still kept going and eventually you can stumble over things, which actually work.

Laughing, because I didn’t buy a Rife Machine, but I did buy a MicroPulse ICES device, maybe even because he wrote Faraday’s Law out for me.

It has helped me with a lot of things, and I do ponder if it generates enough of an electric field to do anything really amazing, but it gets rid of injury pain. Every once in a while I look at it and wonder, “Are you the right type of electric field for the brain tumor studies” but that is not what it is being sold for.

I started looking up the ingredients in chocolate, like carrageenan and things like caffeine, cannabinoids and phenylethylamine.

While I was on the cannabinoids, I found an article about a link between schizophrenia and marijuana. I know a few people who were normal before using, who were schizophrenic after.

I have to say that I don’t even like it when my chocolate makers use anything to increase addiction or injure my health. I stopped eating chocolate a year ago and was probably addicted out of a low magnesium level, but it just feels good to not have any addictions. I got rid of coffee, too, and milk and cheese. Hooray for getting rid of all of it.

I have pondered the cocoa, because I had heard that they could fight cancer. I think it is in Bill Henderson’s how to fight cancer for $5 and something cents book. Not sure. I just like that there was a book with that title.

I don’t want to let it back in.

I will need to research if there is a way to let the good parts in, without the bad parts.

I have organic cocoa powder in hot filtered water usually with a herb or 2 every day (no toxic dairy, no toxic sugar). If I take it at night, occasionally I wake up the following morning with nausea and vertigo which lasts for a few hours to the whole day. There is no reaction if I take it in the morning. So there appears to be some toxic reaction to cocoa but being the superfood it is, I would say the health benefits out weigh the detrimental effects. Just dont do it at night and yes I do tend to put a heaped tablespoon in or more to 1 cup.

Hetrazom, I have eaten/drank cacao many times at night in much bigger amounts than a tbsp and have never had that reaction. The worst it has ever done at times was keep me awake a bit longer because it’s so stimulating. One thing though, it puts me in such a good mood! Gotta love all those love hormones. Also, a lot of people drink cocoa in the evening and I’ve never heard of that so I wouldn’t conclude that there’s a toxic reaction. Have you tried different brands of cocoa? Maybe it’s the herbs? Anyways, cocoa and herbs sounds good! What kind of herbs do you use? I should try it.

Were the subjects in all the included studies omnivores to begin with? How fiber deficient were they to begin with? Etc. Doesn’t really matter too much I guess. Just a bit sad if Cacao contributes to acne in acne-prone individuals.

I think the bottom line is that if you’re suffering from acne and you’re following an omnivorous diet, just start by going 100% Plant-based and eat whatever plant foods you desire including gluten-based foods and cacao-based foods.

Try it out for 1-2 months. If you clear up your acne then you’re good to go. If you see an improvement, but not 100% then cut out all gluten foods and all cacao foods. If you clear up 100% then add back just gluten, or just cacao, and so on.

Lots of things kill cancer cells in the laboratory – from bleach to beer to camel urine. And even the blood of vegetarians. That doesn’t prove that consuming those things helps to prevent or fight cancer.

I eat at least a tbsp of cacao powder everyday and often have VERY chocolate-y (healthy) desserts that I make myself with cacao powder and sometimes eat cacao nibs (mostly in my nut and seed mixes) and I never have any issue or differences in my skin, however I’ve never been acne prone. Based off my own experiences and observations of others I know, I would imagine this applies to those who are already acne prone. I wonder why that is though… Any insight coming up on what causes the reaction?
Also the Kuna Indians drink cups of cacao everyday but I’ve never heard of them standing out for having statistically more acne… maybe they just aren’t typically acne prone? Anyways, I’d like to know the cause.

This might sound incredibly stupid and I doubt it is so, but could the antioxidants of the cacoa be having a detoxing effect? I almost feel stupid posting this but just thinking out loud and honestly I don’t know that much about the way our skin works.

All I know is years ago whenever I would eat a lot of chocolate like at Xmas, Easter, or halloween, I got a big ole pimple at the same place every time. No randomized double blind placebo needed for me!. :-)

I was trying to look up the nonorganic cacao and was trying to learn the difference in cacao and cocoa and I ended up on Livestrong learning about the bugs and bug parts and bug droppings they allow in it.

If I still had Cancer symptoms and was starting over, I think I woild be doing modified Gerson juicing, but I would be adding Kale and Matcha and Flax Seed and Turmeric to my juices and for some reason a Matcha tea enema feels cleaner to me than coffee enemas, which I never could get myself to do.

Deb, animal droppings that might end up in something isn’t “non-vegan,” its just nature, albeit the grosser side. What would make that non-vegan would be if the droppings were purposefully added after exploiting said animals for their feces. And certainly purposefully eating insects isn’t vegan, but accidentally swallowing a gnat for example, doesn’t make you less of a vegan. Just thought I’d clarify :)

Study was done only on males, small study (13 subjects), restricted ages (18–35), omnivorous diet to be presumed.
It used as much as 170g of cocoa. (That’s up to a whopping ~23 g of fat).
We know from practice (I am a nutritionist) that fat intake plays an important role on acne.

Did the study standardize the diets for fat intake? Did the subjects all eat the same thing diet? Sadly, no. How do we know the changes (or lack of for some) aren’t from something else ate, or didn’t eat? We can’t.

Typical example of how even a double-blind placebo-controlled study, with no apparent industry funding or conflict of interest, can still be a very poor study, because of shortcomings in their design. You can’t overlook these things.

Until a similar study looks into more people, with less discrimination, and feeds them ***a standardized diet*** that controls for total , there’s no conclusion to be drawn on cocoa at the kind of low-dose people actually use it at (<1 ounce in beverages). You can still decide to skip it if you are prone to acne if you want…along with other high-fat foods perhaps. But bottom-line: this study is of (unfortunately under-stated) very poor quality. As such, it should not be used to formulate recommendations. Making recommendations based on this would be both poor scientific journalism and reductionism.

Conflict of interest statement: I have no personal bias in favour of cocoa. If anything am pro-low-fat diet (~10% fat) because of the evidence. I rarely ever use/eat cocoa powder.

Hi, Youcef. You are right that this study has limitations, some of which are noted in the video. I think it is featured because, so far, it is the only one we know of to test cocoa powder in this particular way. It would be great to see some larger, more inclusive, and well-designed studies on this subject! It even occurred to me that, at 240 capsules in a day, the material in the capsules themselves could be a factor. Until better research is conducted, this is what is available to us.

Hi Christine,
Fair enough. But if the best available evidence, is, like this study, of extremely poor design, it seems sensible to not even include it.
Thankfully, this topic is not the most grave of all. Recommendations based on poor study/analysis/interpretation won’t have the gravest consequences in this particular instance of cocoa vs. acne, especially if erring on the side of not having the high-fat food in question.

A far less forgiving topic is fat intake vs. overall health.NF/Dr. Greger have relied on far poorer studies to make recommendations in favour of high-fat foods, allegedly to reduce LDL or improve nutrient absorption. This is very concerning considering the known effects of a high fat intake on general health. I have analysed those studies thoroughly to demonstrate they were funded/influenced by industry in ways that were understated/unmentioned, and are of such extremely poor design they should have never been shortlisted, let alone heavily relied on to derive recommendations.

I am thankful and admire the sheer effort and outreach you folks are achieving, and surely encourage the work you do.
My intention in sharing this are to invite NF/Dr. Greger:
1) to increase the quality standards of the literature reviews done at NF
2) and perhaps as well re-evaluate the pro-high fat position by reviewing the science/funding/authors more thoroughly

Youcef, sounds like you simply have a decided stance (one might even say bias) on an extremely low fat diet. However, Dr. Greger and Nutritionfacts.org cites some of the best studies known to man. The science doesn’t show that plant foods naturally high in fat such as nuts and seeds are harmful to health but rather on the contrary. Also, from what I’ve seen, Dr. Greger actually shows that you can get all the benefits of fat soluble vitamins from adding a couple walnuts to your salad.. doesn’t exactly constitute as high fat to my mind. But in any case, one thing in particular that makes Dr. Greger and his team incredible researchers is that they read through the existing evidence and go with what the best available evidence has to say, whereas someone who approaches their research through a bias, might only look for things supporting their beliefs even if they do so subconsciously.

In the avocado LDL video you link to, it is made clear that the particular study you are critical of (the video refers to multiple studies) refers to the effect of replacing animal fats with plant fats.

Hi,
How does vegan diet can help gastroperosis if most of the plant based food has tons of fiber? Also although plant based protein like chickpeas and lentils, they are still loaded with fiber. What’s the solution please?

You may therefore find that using a blender makes consumption of fibre containing foods more tolerable and might permit a higher level of plants in your diet. I don’t know but it may be worth a short personal trial if your doctor is OK with that.

Of course! Even if cocoa causes acne in acne-prone individuals, it certainly doesn’t take away it’s many other health benefits. But if it does seem to break you out, I’d imagine he’d simply suggest choosing another high antioxidant food instead. Kind of like nutritional yeast… awesome stuff and he recommends it, but also says that it should probably be avoided by those with certain autoimmune disorders such as Crohn’s.

I just came across this human study on the effects of high antioxidant cocoa consumption for the protection of skin from UV light which found a significant increase in protection of the skin in the high antioxidant cocoa but no change in the low antioxidant cocoa.

It also mentions another study of the application of cocoa polyphenols applied to ex vivo human skin explants which showed an increase in glycosaminioglycans and improved collagen in the skin: “With regard to topical application of HF cocoa extracts, there is not much scientific data available in the literature yet. However, a recent study using ex vivo human skin explants showed that topical application of cocoa polyphenols increased glycosaminoglycans in the skin and improved collagen I, III, and IV content.”

joakim- You requested a video on the drug accutane. Most NF videos are on foods or health-related subjects not specifically on drugs. However, Dr. Greger did a video mentioning accutane and comparing it to a food for therapy benefits. Please check this out, https://nutritionfacts.org/video/treating-acne-barberries/ if you haven’t seen it already. Hope that helps.

Great video! And this theory makes complete sense for me! I stopped eating all foods and beverages containing cocoa/cacao on January 3rd 2018, to see if the sudden onset of cystic acne and acne rosacea that started for me 2 years ago, would improve (I am currently 36 years of age). Prior to this, I would say that my consumption of cocoa/cacao was moderate to high. My diet was mostly WFPB but not completely. I didn’t always consume cocoa/cacao with sugar, most of the time it was in a smoothie or a refined-sugar-free and WFPB dessert. I didn’t have any skin problems at all before this sudden change two years ago and I also didn’t always consume as much cocoa/cacao as I have in the last few years. I went a little overboard with the GF vegan desserts! Could the fat content in some these desserts that I was making and eating have contributed to the acne and rosacea as well? Possibly. What I do know for sure, is that as far as my skin is concerned, lower fat intake and zero cocoa/cacao intake work for me. It has only been 3 months since I removed all cocoa/cacao from my diet and my skin is completely clear. My skin cleared up after about 4 weeks and has been clear since then. I am currently reading ‘How Not To Die’ and I am learning so much! I am really enjoying the read and I feel empowered and motivated! Thank you Dr Gregor!! You are a true breath of clean fresh air in a very polluted, ‘noisy’ and confusing health industry!

A quick look at the authors starts the suspicion. The poster of the article is a person who appears to make his living telling people to eat tons of meat and dairy and writes for fitness blogs, does interviews to that end.
That isn’t a cause to doubt by itself, but it does get to the motivation for him posting it.

The actual writer seems to have published mostly for Norwegian language publications, and I don’t know that language. A cursory scan and some google translate lead me to suspect he is heavily involved in dairy related publishing. That could be an actual credit, he may be an expert. He may also be funded by dairy. I rarely find authors so heavily published on the topic of dairy in the English language that don’t get some kind of dairy dollars.

Now to the studies. The institutes that published these studies (I looked at the first four and stopped, admittedly, if you wish to be more thorough please go ahead) are in fact supported by dairy dollars, or by government institutions that have dairy promotion in their mission statement (the USDA is an example of a government organization that is committed to promoting the American dairy industry according to their mission statement).

I tend to place much more weight on more thorough studies (larger sample size, metadata analysis, population studies, etc) and more recent studies.
But the most important factor to me is “where did the money come from”. We saw for decades that smoking was either good for you or bad for you depending on where the money came from. This has been true for many other products that are patently unhealthy and harmful. Even if these bovine growth hormone studies are true, no claims are made to the point that dairy is the number one source of saturated fat which is the number one cause of the number one killer in America.

Sorry, but even without the industry ties, these studies are not even attempting to refute the number one concern about dairy products: they literally break our hearts.

Dr. Greger – I have struggled with acne since I was a teenager (I am now 28). I took Accutane in high school, along with a plethora of other prescription medications, and unfortunately, did not realize lasting effects of it. I eat a whole foods, plant-based diet (like you recommend) and still suffer from acne. I noticed that not eating dairy helped a little, but I would still consider it moderate acne. I stopped eating chocolate about 2 months ago, drink green tea every morning, only use all-natural and organic skin care products (cleanser, moisturizer, most of which include green tea), eat significantly more broccoli than I used to, and I even eat barberries – all to no avail. I am at a loss for what else I can do to improve it. My dermatologist recommended more pills and a second round of Accutane, which I am adamantly opposed to. But….. it would be nice to not deal with this anymore. I am not overweight, practice yoga regularly, and consider myself very healthy. Do you have any suggestions for how I can improve this without going the pharmaceutical route?

Hi Brooke- What a challenge! It sounds like you are doing a great job at your lifestyle and yet still struggle with this problem. You probably are already doing this, but it’s of course important to avoid processed oils, processed foods as whole, and to assure your foods have a low glycemic index, as these are also factors in acne.

There can be, of course, non dietary factors in acne. It would be idea to get advice on next steps from a whole food, plant based, dermatologist. You could search for one at plantbaseddoctors.org. If you can find one, they’d be best to give you advice on what to do next if a healthy lifestyle isn’t enough.

Thank you for the quick response!! I do not eat processed foods, though I do cook with olive oil. Should I eliminate it from my diet? I don’t generally cook with any other kinds of oil.

I checked out that website but there are only two dermatologists listed- one in Australia and one across the country. :(

I will look into the low glycemic index foods. Though, since I don’t eat sweets (exception being fruit!), I do eat brown rice rather than white, sweet potatoes, rather than russet, and other healthier alternatives, etc., I would assume that my diet is already low glycemic index, just based on being whole food, plant based?

Aside from eliminating oil from my cooking (which I will start doing now), I feel like I do everything else correctly, so if you can think of anything else that I could try or might have missed, please let me know.